MEDICARE: WELLPATRIOT VETERANS MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1972367589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLPATRIOT VETERANS MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	5112 CRESCENT COVE LN
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-7622
Country	:	US
Telephone Number	:	770-378-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 MIAMI CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3015
Country	:	US
Telephone Number	:	404-936-6216
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIEF MEDICAL OFFICER
Name	:	DR. KEVIN WASHINGTON SR.
Credential	:	MD
Telephone Number	:	770-378-0942

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	05/28/2024

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